Racial disparities in transcatheter aortic valve replacement: A contemporary nationwide analysis

Racial disparities have been reported in the management of cardiovascular diseases. Transcatheter aortic valve replacement (TAVR) volume continues to increase with evolving indications and practice changes.

This study aims to provide insight regarding procedure access and outcomes to evaluate for potential racial disparities in the contemporary era of TAVR.

TAVR patients (aged ≥18) were identified in the National Inpatient Sample from 2016 to 2019 and grouped by race. Baseline characteristics and in-hospital outcomes were compared between White and non-White patients before and after propensity-score matching. Primary outcomes were in-hospital mortality and a composite outcome. The individual components of the composite outcome served as secondary outcomes.

Of 42,877 total TAVR patients, 37,319 were White and 5558 were non-White. Annual procedure volume in both groups increased significantly (Ptrend < 0.001 for both). The proportions of White and non-White patients remained steady over time (12.5%-13.5% non-White, Ptrend = 0.117). The characteristics of White and non-White patients differed significantly. There was no difference in in-hospital mortality (1.5% vs 1.6%, P = 0.585) or composite outcome (23.8% vs 24.6%, P = 0.316). Non-White race was associated with higher rates of acute renal failure (odds ratio [OR]:1.21, 95% confidence interval [CI]:1.10-1.33, P < 0.001), transfusion (OR:1.18, 95%CI:1.05-1.32, P = 0.006), and vascular complications (OR:1.62, 95%CI:1.29-2.04, P < 0.001), but lower rates of permanent pacemaker implantation (OR:0.83, 95%CI:0.75-0.93, P = 0.001).

TAVR remains safe in both White and non-White patients with comparable in-hospital mortality and overall outcomes. Differences in baseline characteristics and individual complications indicate the presence of racial disparities in procedure accessibility and outcomes.Meeting presentation: Presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2024, October 27-30, 2024, Washington D.C.